Reduced forced expiratory flow between 25% and 75% of vital capacity in children with allergic rhinitis without...

Allergic rhinitis (AR) and asthma are closely associated in children. Reduced FEF_25%-75% which reflects small airway airflow limitation is frequently observed in asthma. This study aimed to examine the proportion of small airway dysfunction in children with AR and to determine its associated factors.Methods: The medical records of 144 aged 6-18-year children with AR without overt asthmatic symptoms were retrospectively reviewed. Subjects were divided into 2 groups according to the FEF_25%-75% values; normal FEF_25%-75% group (n = 129) and reduced FEF_25%-75% group (n = 15). Clinical data, allergen sensitization profile, exhaled nitric oxide, spirometry, and methacholine provocation test results were compared between the two groups.Results: The mean FEV₁ and FEF_25%-75% values in the reduced FEF_25%-75% group (73.5 ± 9.4%pred and 56.0 ± 7.7%pred, respectively) were significantly lower than in the normal FEF_25%-75% group (87.0 ± 12.5%pred and 99.1 ± 21.4%pred, respectively). The mean disease duration was significantly longer in the reduced FEF_25%-75% group than in the normal FEF_25%-75% group (5.39 ± 1.85 y vs 3.14 ± 1.80 y, p < 0.001). Subjects with positive bronchial hyperresponsiveness (MChPC₂₀<16 mg/mL) were more frequently detected in the reduced FEF_25%-75% group than in the normal FEF_25%-75% group (26.7% vs 8.52%, p = 0.013). Long disease duration and severity of AR were significantly associated with impaired FEF_25%-75% values.Conclusions: Subjects with AR alone may have impaired FEF_25%-75% values which is considered as a marker of early bronchial involvement. Longer disease duration and severity of AR are important risk factors for progressive declines in small airway function. Physicians should be aware of need for the measurement of FEF_25%-75% values for early detection of small airway dysfunction, particularly in children with severe long-lasting allergic rhinitis.